Ambulance Work in Liberia Is a Busy and Lonely Business

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Some ambulance workers in Monrovia have been infected with Ebola, while others have been attacked for not getting to patients in time.Published OnOct. 16, 2014CreditImage by Ben C. Solomon/The New York Times

MONROVIA, Liberia — Racing along cracked and bumpy roads here, Gordon Kamara shouted into his cellphone over the shrieking sirens of his ambulance. The phone had been ringing nonstop since 5 a.m.

“Not today! Not today!” Mr. Kamara, an ambulance nurse, yelled later in the day. “We are on the opposite side of town!”

The calls have all been the same in recent weeks: from friends, friends of friends, extended family, complete strangers. All of them have loved ones sick with Ebola and beg him to come quickly. Seven days a week, Mr. Kamara and his crew span Monrovia, Liberia’s capital, in a donated, old American ambulance — with California license plates still attached.

“It never stops,” said Mr. Kamara, getting another call the moment he hangs up.

The 15 or so ambulance teams bolting around the city have had many days of hard choices like this. Hundreds of new Ebola cases are reported each week in Monrovia, with many more never accounted for. And over the course of the epidemic, only a small percentage of them have ever made it to a hospital.

“We see it flow through the communities; first one, then many,” Mr. Kamara said. “The map is being painted red with the virus.”

To confront the spread of Ebola, some community groups have stepped in, motivated by altruism, desperation and, in some cases, political opportunism.

In some neighborhoods, teams of volunteers fan out to track victims and educate households on staving off the virus, though their pockets are so shallow that they often do not have enough supplies, like chlorine, to thwart the epidemic’s advance.

Mr. Kamara does not work for the government. He does not even have a dispatcher to tell him where to go, or which patients to pick up. Instead, his team is financed by an opposition member of Parliament, Saah H. Joseph, who imported two used American ambulances to Monrovia this year.

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Gordon Kamara, an ambulance nurse, checking on a body in the middle of a street last month. A video about Mr. Kamara’s experiences is at nytimes.com/video.CreditDaniel Berehulak for The New York Times

Mr. Joseph claims to bankroll the operation on his meager government salary, and he deployed the ambulances even before Ebola overran this city. It was a way of shoring up Monrovia’s tattered health system — and of making a name for himself.

But many here wonder whether other political opponents of President Ellen Johnson Sirleaf are the real money behind Mr. Joseph’s ambulance squads, hoping to use them as a form of public shaming of the government.

There is little question that the city has long suffered a major ambulance shortage. And since the epidemic struck, other independent ambulance teams have sprung up, adding a few more vehicles to what is still a tiny fleet in this sprawling city of nearly 1.5 million people.

At the end of a recent 15-hour shift, Mr. Kamara took his final patient of the night, a 17-year-old girl, to an Ebola treatment center. Wrought with fever, she had stripped off her clothes in the back of the ambulance and fallen off the stretcher, lying twisted and barely conscious on the floor.

“If she does not get treatment, she will die,” Mr. Kamara said.

But as soon as they arrived, he and his team were turned away. All the beds were full. The center, meant to house 50 patients, was packed with 85.

“We could either leave her on the ground to die, or return her to die at home,” Mr. Kamara said. “There’s no hope here.

“We try our best. But we cannot do more than we can do.”

In recent days, the flow of patients, somewhat inexplicably, seems to have slowed, and beds are suddenly available in some places. Many people wonder if it is a reflection of international efforts to add treatment slots, or a sign that some clinics are seen as deathtraps from which sick relatives will never return, leaving many patients to opt for taking their chances at home instead.

But the current ebb is a rare — and not entirely trusted — respite from the typical frenzy. Most days, Mr. Kamara and his team work from sunrise to long past sunset, often sleeping in the ambulance for rest. On a slow day, he has ferried 10 to 15 new patients from their homes to Ebola treatment centers. On a busy day, the number has been between 20 and 30.

“When there are beds at the centers, we can do our work,” Mr. Kamara said. “When there aren’t, we must sit and wait,” he added, explaining that his ambulance would sometimes wait outside a hospital for hours, with a patient in the back, until a treatment slot opened up.

Mr. Kamara is no stranger to suffering. More than a decade ago, he worked as a combat medic during Liberia’s civil war.

“It is nothing compared to this,” he said. “The bullets you can get away from. Ebola is hidden within our own families.”

Last month, he received news of an uncle falling ill. He rushed to the hospital to help, only to be turned away by workers there.

“Nobody knows who is alive or who is dead in here!” Mr. Kamara shouted. “I would go treat him myself if they let me. I just want to protect my family.”

He takes many precautions at home. With his constant exposure to the virus, he sleeps in a separate house from his six children to prevent them from getting sick. In the past five months, he has seen them only a few times.

“It’s a very lonely virus,” Mr. Kamara said. “Not just for me, but for the entire country. We are all together, but all alone.”

As he returned the 17-year-old girl to her home, Mr. Kamara explained to her brother why they had brought her back.

“We didn’t want to leave her outside and alone,” he said. “We will come back to pick her up tomorrow in the morning and try again.”

Her brother calmly accepted the news. He thanked the ambulance crew for trying, and opened the door as they carried her limp body inside the house.

She died the next morning, before the ambulance team could return.

A version of this article appears in print on , on Page A18 of the New York edition with the headline: On Ambulance in Liberia Ebola Zone, Work Is Desperate and Lonely. Order Reprints | Today’s Paper | Subscribe